严重坏死性筋膜炎后致死结局的预测因素：20 年回顾性分析一家三级医院。

Predictors of fatal outcome after severe necrotizing fasciitis: Retrospective analysis in a tertiary hospital for 20 years.

机构信息

Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan.

出版信息

J Orthop Sci. 2021 May;26(3):494-499. doi: 10.1016/j.jos.2020.04.007. Epub 2020 May 12.

DOI:10.1016/j.jos.2020.04.007

PMID:32414564

Abstract

BACKGROUND

Prognostic factors for fatal outcomes of patients with necrotizing fasciitis remain unclear.

METHODS

We retrospectively analyzed data of patients with necrotizing fasciitis from January 1998 to July 2019 using our hospital's medical database. Clinical characteristics of patients who died during hospitalization or had been discharged were evaluated. Sex, age, body mass index, smoking history, alcohol use, comorbidities (diabetes mellitus, arteriosclerosis obliterans, heart disease, obstructive arteriosclerosis, dialysis, cancer, skin disease, steroid use history), shock vital, physical findings, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, sepsis, disseminated intravascular coagulation, fascial administration, tracheal intubation, and surgical treatment (dismemberment and/or debridement) were compared between the survivor (group S) and nonsurvivor (group N) groups.

RESULTS

Fifty-five patients with necrotizing fasciitis were included (40 patients in group S and 15 patients in group N). Serum creatine was a significant prognostic factor (odds ratio [OR], 3.03; 95% confidence interval [CI], 0.15-0.75; P = 0.0078), with a cutoff value of 1.56 mg/dL. Moreover, the estimated glomerular filtration rate was a significant prognostic factor (OR, 1.06; 95% CI, 1.02-1.10, P = 0.000548), with a cutoff value of 20.6 mL/min.

CONCLUSION

Renal dysfunction is a significant prognostic factor for fatal outcomes of patients with necrotizing fasciitis.

LEVEL OF EVIDENCE

Level IV, Case series.

摘要

背景

坏死性筋膜炎患者致命结局的预后因素仍不清楚。

方法

我们使用医院的医疗数据库回顾性分析了 1998 年 1 月至 2019 年 7 月期间坏死性筋膜炎患者的数据。评估了住院期间死亡或已出院患者的临床特征。比较了存活组（组 S）和非存活组（组 N）患者的性别、年龄、体重指数、吸烟史、饮酒史、合并症（糖尿病、动脉硬化闭塞症、心脏病、阻塞性动脉硬化、透析、癌症、皮肤病、类固醇使用史）、休克生命体征、物理检查、实验室感染性坏死性筋膜炎风险指数（LRINEC）评分、败血症、弥散性血管内凝血、筋膜切开、气管插管和外科治疗（截肢和/或清创）。

结果

共纳入 55 例坏死性筋膜炎患者（组 S 40 例，组 N 15 例）。血清肌酐是一个重要的预后因素（比值比 [OR]，3.03；95%置信区间 [CI]，0.15-0.75；P=0.0078），截断值为 1.56mg/dL。此外，估算肾小球滤过率也是一个重要的预后因素（OR，1.06；95%CI，1.02-1.10，P=0.000548），截断值为 20.6mL/min。